Unusual presentation of bronchogenic carcinoma. Case report and review of the literature

Although blood spread of pulmonary malignancy presumably occurs through microembolization, frank embolization of tumor fragments is uncommon. The first reported case of bronchogenic carcinoma appearing as a peripheral arterial embolus is described. The patient, a 64-year-old female, had acute ischemia of the left leg secondary to tumor embolism to the left profunda femoris and popliteal arteries. Shortly after embolectomy, she suffered atelectasis of the whole left lung from an epithelioid carcinoma in the left main bronchus. Twenty-eight cases of frank tumor embolism to the arterial tree occurring during the course of a non-cardiac malignancy have been reported. None, however, occurred as an initial event. Pulmonary metastasis in patients with advanced malignancy was the source of the arterial emboli in 45% (13/29) of reported cases, but bronchogenic carcinoma was the original cell type in 38% (11/29) of cases. In general, arterial tumor embolism is a complication of advanced malignancy usually originating from one of multiple pulmonary metastases. This first case report of tumor embolism to a lower extremity occurring as the initial event in the clinical course of a bronchogenic carcinoma serves to emphasize the protean manifestations of malignant disease.